Many individuals and families utilize health insurance plans to pay for medical expenses. For example, when an individual visits a physician's office for a medical checkup, the individual may pay for health services with personal funds (e.g., a copayment) and funds provided by a health insurance plan. Typically, to utilize health insurance coverage for health services, an appropriate claim must be filed with the insurance company in order to receive benefits.
Successfully processing a medical insurance claim may require the individual, the insurance company, and/or the healthcare provider to exchange a variety of items, such as payments, claim information, information pertaining to services rendered, and other information. Processing of the medical insurance claim may be complete once each party has provided and/or received the necessary items.
Numerous problems may occur during insurance claim processing. For example, the healthcare provider may file the wrong claim with the insurance company, or the insurance company may improperly deny coverage for a medical procedure covered under an individual's health insurance plan. In other cases, a healthcare provider may transmit an incorrect bill to the insurance company and/or insured individual, such as a bill including incorrect service charges or charges for services that were not rendered. Another example of a problem that may occur during insurance claim processing may include an individual (e.g., a patient) failing to remit payment to a healthcare provider or an individual failing to obtain appropriate referrals for particular health services. In many cases, the responsibility for rectifying such problems lies on the insured individual. For example, it may be necessary for the insured individual to contact the insurance company and/or the healthcare provider to determine steps that have been taken to process the claim as well as steps that need to be taken to complete the processing of the claim.